Impact of neighborhood and individual socioeconomic status on survival after breast cancer varies by race/ethnicity: The Neighborhood and Breast Cancer Study
Published Date:Mar 11 2014
Source:Cancer Epidemiol Biomarkers Prev. 23(5):793-811.
Breast Cancer Survival
Carcinoma, Ductal, Breast
Continental Population Groups
Neighborhood Socioeconomic Status
Pubmed Central ID:PMC4018239
Funding:HHSN261201000034C/PHS HHS/United States
HHSN261201000035C/PHS HHS/United States
HHSN261201000140C/PHS HHS/United States
P30 ES007048/ES/NIEHS NIH HHS/United States
R01 CA140058/CA/NCI NIH HHS/United States
R01 CA63446/CA/NCI NIH HHS/United States
R01 CA77305/CA/NCI NIH HHS/United States
R01CA140058/CA/NCI NIH HHS/United States
R21 CA133255/CA/NCI NIH HHS/United States
R21CA133255/CA/NCI NIH HHS/United States
U58DP003862-01/DP/NCCDPHP CDC HHS/United States
UM1 CA164920/CA/NCI NIH HHS/United States
Research is limited on the independent and joint effects of individual- and neighborhood-level socioeconomic status (SES) on breast cancer survival across different racial/ethnic groups.
We studied individual-level SES, measured by self-reported education, and a composite neighborhood SES (nSES) measure in females (1,068 non-Hispanic whites, 1,670 Hispanics, 993 African-Americans, and 674 Asian-Americans), aged 18–79 years and diagnosed 1995–2008, in the San Francisco Bay Area. We evaluated all-cause and breast cancer-specific survival using stage-stratified Cox proportional hazards models with cluster adjustment for census block groups.
In models adjusting for education and nSES, lower nSES was associated with worse all-cause survival among African-Americans (p-trend=0.03), Hispanics (p-trend=0.01) and Asian-Americans (p-trend=0.01). Education was not associated with all-cause survival. For breast cancer-specific survival, lower nSES was associated with poorer survival only among Asian-Americans (p-trend=0.01). When nSES and education were jointly considered, women with low education and low nSES had 1.4 to 2.7-times worse all-cause survival than women with high education and high nSES across all races/ethnicities. Among African-Americans and Asian-Americans, women with high education and low nSES had 1.6 to 1.9-times worse survival, respectively. For breast cancer-specific survival, joint associations were found only among Asian-Americans with worse survival for those with low nSES regardless of education.
Both neighborhood and individual SES are associated with survival after breast cancer diagnosis, but these relationships vary by race/ethnicity.
A better understanding of the relative contributions and interactions of SES with other factors will inform targeted interventions towards reducing long-standing disparities in breast cancer survival.
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